Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology

Petar M. Seferović, Mark C. Petrie, Gerasimos S. Filippatos, Stefan D. Anker, Giuseppe Rosano, Johann Bauersachs, Walter J. Paulus, Michel Komajda, Francesco Cosentino, Rudolf A. de Boer, Dimitrios Farmakis, Wolfram Doehner, Ekaterini Lambrinou, Yuri Lopatin, Massimo F. Piepoli, Michael J. Theodorakis, Henrik Wiggers, John Lekakis, Alexandre Mebazaa, Mamas A. Mamas & 13 others Carsten Tschöpe, Arno W. Hoes, Jelena P. Seferović, Jennifer Logue, Theresa McDonagh, Jillian P. Riley, Ivan Milinković, Marija Polovina, Dirk J. van Veldhuisen, Mitja Lainscak, Aldo P. Maggioni, Frank Ruschitzka, John J. V. McMurray

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30–40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first-line choice. Sulphonylureas and insulin have been the traditional second- and third-line therapies although their safety in HF is equivocal. Neither glucagon-like preptide-1 (GLP-1) receptor agonists, nor dipeptidyl peptidase-4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium–glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM.
Original languageEnglish
Pages (from-to)853-872
JournalEuropean Journal of Heart Failure
Volume20
Issue number5
DOIs
Publication statusPublished - 2018

Cite this

Seferović, P. M., Petrie, M. C., Filippatos, G. S., Anker, S. D., Rosano, G., Bauersachs, J., ... McMurray, J. J. V. (2018). Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 20(5), 853-872. https://doi.org/10.1002/ejhf.1170
Seferović, Petar M. ; Petrie, Mark C. ; Filippatos, Gerasimos S. ; Anker, Stefan D. ; Rosano, Giuseppe ; Bauersachs, Johann ; Paulus, Walter J. ; Komajda, Michel ; Cosentino, Francesco ; de Boer, Rudolf A. ; Farmakis, Dimitrios ; Doehner, Wolfram ; Lambrinou, Ekaterini ; Lopatin, Yuri ; Piepoli, Massimo F. ; Theodorakis, Michael J. ; Wiggers, Henrik ; Lekakis, John ; Mebazaa, Alexandre ; Mamas, Mamas A. ; Tschöpe, Carsten ; Hoes, Arno W. ; Seferović, Jelena P. ; Logue, Jennifer ; McDonagh, Theresa ; Riley, Jillian P. ; Milinković, Ivan ; Polovina, Marija ; van Veldhuisen, Dirk J. ; Lainscak, Mitja ; Maggioni, Aldo P. ; Ruschitzka, Frank ; McMurray, John J. V. / Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. In: European Journal of Heart Failure. 2018 ; Vol. 20, No. 5. pp. 853-872.
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title = "Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology",
abstract = "The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30–40{\%} of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first-line choice. Sulphonylureas and insulin have been the traditional second- and third-line therapies although their safety in HF is equivocal. Neither glucagon-like preptide-1 (GLP-1) receptor agonists, nor dipeptidyl peptidase-4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium–glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM.",
author = "Seferović, {Petar M.} and Petrie, {Mark C.} and Filippatos, {Gerasimos S.} and Anker, {Stefan D.} and Giuseppe Rosano and Johann Bauersachs and Paulus, {Walter J.} and Michel Komajda and Francesco Cosentino and {de Boer}, {Rudolf A.} and Dimitrios Farmakis and Wolfram Doehner and Ekaterini Lambrinou and Yuri Lopatin and Piepoli, {Massimo F.} and Theodorakis, {Michael J.} and Henrik Wiggers and John Lekakis and Alexandre Mebazaa and Mamas, {Mamas A.} and Carsten Tsch{\"o}pe and Hoes, {Arno W.} and Seferović, {Jelena P.} and Jennifer Logue and Theresa McDonagh and Riley, {Jillian P.} and Ivan Milinković and Marija Polovina and {van Veldhuisen}, {Dirk J.} and Mitja Lainscak and Maggioni, {Aldo P.} and Frank Ruschitzka and McMurray, {John J. V.}",
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Seferović, PM, Petrie, MC, Filippatos, GS, Anker, SD, Rosano, G, Bauersachs, J, Paulus, WJ, Komajda, M, Cosentino, F, de Boer, RA, Farmakis, D, Doehner, W, Lambrinou, E, Lopatin, Y, Piepoli, MF, Theodorakis, MJ, Wiggers, H, Lekakis, J, Mebazaa, A, Mamas, MA, Tschöpe, C, Hoes, AW, Seferović, JP, Logue, J, McDonagh, T, Riley, JP, Milinković, I, Polovina, M, van Veldhuisen, DJ, Lainscak, M, Maggioni, AP, Ruschitzka, F & McMurray, JJV 2018, 'Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology' European Journal of Heart Failure, vol. 20, no. 5, pp. 853-872. https://doi.org/10.1002/ejhf.1170

Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. / Seferović, Petar M.; Petrie, Mark C.; Filippatos, Gerasimos S.; Anker, Stefan D.; Rosano, Giuseppe; Bauersachs, Johann; Paulus, Walter J.; Komajda, Michel; Cosentino, Francesco; de Boer, Rudolf A.; Farmakis, Dimitrios; Doehner, Wolfram; Lambrinou, Ekaterini; Lopatin, Yuri; Piepoli, Massimo F.; Theodorakis, Michael J.; Wiggers, Henrik; Lekakis, John; Mebazaa, Alexandre; Mamas, Mamas A.; Tschöpe, Carsten; Hoes, Arno W.; Seferović, Jelena P.; Logue, Jennifer; McDonagh, Theresa; Riley, Jillian P.; Milinković, Ivan; Polovina, Marija; van Veldhuisen, Dirk J.; Lainscak, Mitja; Maggioni, Aldo P.; Ruschitzka, Frank; McMurray, John J. V.

In: European Journal of Heart Failure, Vol. 20, No. 5, 2018, p. 853-872.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology

AU - Seferović, Petar M.

AU - Petrie, Mark C.

AU - Filippatos, Gerasimos S.

AU - Anker, Stefan D.

AU - Rosano, Giuseppe

AU - Bauersachs, Johann

AU - Paulus, Walter J.

AU - Komajda, Michel

AU - Cosentino, Francesco

AU - de Boer, Rudolf A.

AU - Farmakis, Dimitrios

AU - Doehner, Wolfram

AU - Lambrinou, Ekaterini

AU - Lopatin, Yuri

AU - Piepoli, Massimo F.

AU - Theodorakis, Michael J.

AU - Wiggers, Henrik

AU - Lekakis, John

AU - Mebazaa, Alexandre

AU - Mamas, Mamas A.

AU - Tschöpe, Carsten

AU - Hoes, Arno W.

AU - Seferović, Jelena P.

AU - Logue, Jennifer

AU - McDonagh, Theresa

AU - Riley, Jillian P.

AU - Milinković, Ivan

AU - Polovina, Marija

AU - van Veldhuisen, Dirk J.

AU - Lainscak, Mitja

AU - Maggioni, Aldo P.

AU - Ruschitzka, Frank

AU - McMurray, John J. V.

PY - 2018

Y1 - 2018

N2 - The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30–40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first-line choice. Sulphonylureas and insulin have been the traditional second- and third-line therapies although their safety in HF is equivocal. Neither glucagon-like preptide-1 (GLP-1) receptor agonists, nor dipeptidyl peptidase-4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium–glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM.

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